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. 2021 Jun;19(6):1258-1266.e1.
doi: 10.1016/j.cgh.2020.08.012. Epub 2020 Aug 12.

Associations Between Reproductive and Hormone-Related Factors and Risk of Nonalcoholic Fatty Liver Disease in a Multiethnic Population

Jun Wang  1 , Anna H Wu  1 , Frank Z Stanczyk  2 , Jacqueline Porcel  3 , Mazen Noureddin  4 , Norah A Terrault  5 , Lynne R Wilkens  6 , Veronica Wendy Setiawan  7
Affiliations

Associations Between Reproductive and Hormone-Related Factors and Risk of Nonalcoholic Fatty Liver Disease in a Multiethnic Population

Jun Wang et al. Clin Gastroenterol Hepatol. 2021 Jun.

Abstract

Background & aims: Despite apparent differences between men and women in the prevalence and incidence of nonalcoholic fatty liver disease (NAFLD), there are limited epidemiologic data regarding the associations of reproductive and hormone-related factors with NAFLD. We examined the associations of these factors and exogenous hormone use with NAFLD risk in African American, Japanese American, Latino, Native Hawaiian, and white women.

Methods: We conducted a nested case-control study (1861 cases and 17,664 controls) in the Multiethnic Cohort Study. NAFLD cases were identified using Medicare claims data; controls were selected among participants without liver disease and individually matched to cases by birth year, ethnicity, and length of Medicare enrollment. Reproductive and hormone-related factors and covariates were obtained from the baseline questionnaire. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs.

Results: Later age at menarche was associated inversely with NAFLD (Ptrend = .01). Parity, regardless of number of children or age at first birth, was associated with increased risk of NAFLD (OR, 1.25; 95% CI, 1.05-1.48). Oral contraceptive use also was linked to increased risk of NAFLD (OR, 1.14; 95% CI, 1.01-1.29; duration of use Ptrend = .04). Compared with women with natural menopause, those with oophorectomy (OR, 1.41; 95% CI, 1.18-1.68) or hysterectomy (OR, 1.33; 95% CI, 1.11-1.60) had an increased risk of NAFLD. A longer duration of menopause hormone therapy (only estrogen therapy) was linked with an increasing risk of NAFLD (OR per 5 years of use, 1.08, 95% CI, 1.01-1.15).

Conclusions: Findings from a large multiethnic study support the concept that menstrual and reproductive factors, as well as the use of exogenous hormones, are associated with the risk of NAFLD.

Keywords: Birth Control; NASH; Steatosis; Worldwide.

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Conflict of interest statement

Disclosures: All authors have no conflicts of interest to declare.

Comment in

References

    1. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology (Baltimore, Md). 2016;64(1):73–84. Epub 2015/12/29. - PubMed
    1. Setiawan VW, Stram DO, Porcel J, et al. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Hepatology. 2016;64(6):1969–77. - PMC - PubMed
    1. Lonardo A, Bellentani S, Argo CK, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2015;47(12):997–1006. Epub 2015/10/12. - PubMed
    1. Lonardo A, Carani C, Carulli N, et al. ‘Endocrine NAFLD’ a hormonocentric perspective of nonalcoholic fatty liver disease pathogenesis. Journal of hepatology. 2006;44(6):1196–207. Epub 2006/04/19. - PubMed
    1. Lonardo A, Nascimbeni F, Ballestri S, et al. Sex Differences in NAFLD: State of the Art and Identification of Research Gaps. Hepatology (Baltimore, Md) 2019. Epub 2019/03/30. - PMC - PubMed

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